Analysis of Mechanical Thrombectomy for Acute Ischemic Stroke on Nights and Weekends Versus Weekdays at Comprehensive Stroke Centers

Potts, Matthew B.; Abdalla, R; Golnari, Pedram; Sukumaran, Madhav; Palmer, Aaron H.; Hurley, Michael C.; Shaibani, Ali; Jahromi, Babak S.; Ansari, Sameer A.

doi:10.1016/j.jstrokecerebrovasdis.2021.105632

Cited by 12 publications

(19 citation statements)

References 28 publications

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“…Similar to previous multicenter studies 16,[24][25][26][27] , this study did not reveal a difference in the prognosis or rate of complications between the two groups. Benali et al observed a significantly higher rate of good functional outcomes among inpatients admitted at night (51% vs. 35%, P = 0.05) 28 , but another study found a higher mortality rate among patients admitted at night for EVT 29 , which may be due to the heterogeneity of the stroke center process and sample size.…”

Section: Discussionsupporting

confidence: 91%

Workflow Intervals andOutcomesof Endovascular Treatment for Acute Large-Vessel Occlusion During On- Versus Off-Hours in China The ANGEL-ACT Registry

Ding

Gao

et al. 2021

Preprint

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Background Acute ischemic stroke (AIS) leads to a substantial burden of disease among the elderly. There may be a delay in or a poor outcome of endovascular treatment (EVT) among AIS patients with large-vessel occlusion (LVO) during off-hours. By using a prospective, nationwide registry, we compared the workflow intervals and radiological/clinical outcomes between patients with acute LVO treated with EVT presenting during off- and on-hours. Methods We analyzed prospectively collected Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke (ANGEL-ACT) data. Patients presenting during off-hours were defined as those presenting to the emergency department from Monday to Friday between the hours of 17:30 and 08:00, on weekends (from 17:30 on Friday to 08:00 on Monday), and on national holidays. We used logistic regression models with adjustment for potential confounders to determine independent associations between the time of presentation and outcomes. Results Among 1788 patients, 1079 (60.3%) presented during off-hours. The median onset-to-door time and onset-to-reperfusion time were significantly longer during off-hours than on-hours (165 vs 125 minutes, P=0.002 and 410 vs 392 minutes, P=0.027). However, there were no significant differences between patients presenting during off- and on-hours in any radiological/clinical outcomes (mRS score: 3 vs 3 points, P=0.204; mortality: 15.9% vs 14.3%, P=0.172; successful reperfusion: 88.5% vs 87.2%, P=0.579; sICH: 7.2% vs 8.4%, P=0.492). Conclusions Off-hours presentation in the nationwide real-world registry was associated with a delay in the visit and reperfusion time of EVT in patients with AIS. However, this delay did not lead to worse radiological/clinical outcomes.

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Section: Discussionsupporting

confidence: 91%

Workflow Intervals andOutcomesof Endovascular Treatment for Acute Large-Vessel Occlusion During On- Versus Off-Hours in China The ANGEL-ACT Registry

Ding

Gao

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Similar to previous multicenter studies (16,(24)(25)(26)(27), this study did not reveal a difference in the prognosis or rate of complications between the two groups. Benali et al observed a significantly increased rate of good functional outcomes among inpatients admitted at night (51 vs. 35%, P = 0.05) (28), but another study found a higher mortality rate among patients admitted at night for EVT (29), which may be due to heterogeneity in stroke center processes and sample sizes.…”

Section: Discussionsupporting

confidence: 90%

Workflow Intervals and Outcomes of Endovascular Treatment for Acute Large-Vessel Occlusion During On-Vs. Off-hours in China: The ANGEL-ACT Registry

Ding

Gao

et al. 2021

Front. Neurol.

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Background: There may be a delay in or a poor outcome of endovascular treatment (EVT) among acute ischemic stroke (AIS) patients with large-vessel occlusion (LVO) during off-hours. By using a prospective, nationwide registry, we compared the workflow intervals and radiological/clinical outcomes between patients with acute LVO treated with EVT presenting during off- and on-hours.Methods: We analyzed prospectively collected Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke (ANGEL-ACT) data. Patients presenting during off-hours were defined as those presenting to the emergency department from Monday to Friday between 17:30 and 08:00, on weekends (from 17:30 on Friday to 08:00 on Monday), and on national holidays. We used logistic regression models with adjustment for potential confounders to determine independent associations between the time of presentation and outcomes.Results: Among 1,788 patients, 1,079 (60.3%) presented during off-hours. The median onset-to-door time and onset-to-reperfusion time were significantly longer during off-hours than during on-hours (165 vs. 125 min, P = 0.002 and 410 vs. 392 min, P = 0.027). The rates of successful reperfusion and symptomatic intracranial hemorrhage were similar in both groups. The adjusted odds ratio (OR) for the 90-day modified Rankin Scale score was 0.892 [95% confidence interval (CI), 0.748–1.064]. The adjusted OR for the occurrence of functional independence was 0.892 (95% CI, 0.724–1.098), and the adjusted OR for mortality was 1.214 (95% CI, 0.919–1.603).Conclusions: Off-hours presentation in the nationwide real-world registry was associated with a delay in the visit and reperfusion time of EVT in patients with AIS. However, this delay was not associated with worse functional outcomes or higher mortality rates.Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03370939.

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“…Potential reasons for delay in our hospital are the relatively high rate of periinterventional intubation during the study period (62.1%) and repeated imaging after arrival at our center as a standardized procedure. In patients from the German stroke registry who received repeated imaging, door-to-groin times were comparable to our data (door-to-image time: 15 min [10][11][12][13][14][15][16][17][18][19][20][21][22][23]; image-to-angio time: 22 min ; angio-to-groin time: 20 min [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]) (18). Moreover, door-togroin puncture times were significantly delayed in patients who received repeated imaging in a recent report from the Amsterdam stroke registry (19).…”

Section: Discussionsupporting

confidence: 80%

“…Admission on weekends was independently associated with longer door-to-groin puncture times in comprehensive stroke center patients in the German stroke registry (odds ratio 1.61; 95% CI 1.37-1.97) (18). However, despite delay of door-to-groin puncture times during on call periods, groin-to-reperfusion times and functional outcomes were unchanged in a recent study (28).…”

Section: Discussionmentioning

confidence: 91%

Team Prenotification Reduces Procedure Times for Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion Who Are Transferred for Endovascular Therapy

et al. 2022

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Background: The clinical benefit from endovascular therapy (EVT) for patients with acute ischemic stroke is time-dependent. We tested the hypothesis that team prenotification results in faster procedure times prior to initiation of EVT.Methods: We analyzed data from our prospective database (01/2016–02/2018) including all patients with acute ischemic stroke who were evaluated for EVT at our comprehensive stroke center. We established a standardized algorithm (EVT-Call) in 06/2017 to prenotify team members (interventional neuroradiologist, neurologist, anesthesiologist, CT and angiography technicians) about patient transfer from remote hospitals for evaluation of EVT, and team members were present in the emergency department at the expected patient arrival time. We calculated door-to-image, image-to-groin and door-to-groin times for patients who were transferred to our center for evaluation of EVT, and analyzed changes before (–EVT-Call) and after (+EVT-Call) implementation of the EVT-Call.Results: Among 494 patients in our database, 328 patients were transferred from remote hospitals for evaluation of EVT (208 -EVT-Call and 120 +EVT-Call, median [IQR] age 75 years [65–81], NIHSS score 17 [12–22], 49.1% female). Of these, 177 patients (54%) underwent EVT after repeated imaging at our center (111/208 [53%) -EVT-Call, 66/120 [55%] +EVT-Call). Median (IQR) door-to-image time (18 min [14–22] vs. 10 min [7–13]; p < 0.001), image-to-groin time (54 min [43.5–69.25] vs. 47 min [38.3–58.75]; p = 0.042) and door-to-groin time (74 min [58–86.5] vs. 60 min [49.3–71]; p < 0.001) were reduced after implementation of the EVT-Call.Conclusions: Team prenotification results in faster patient assessment and initiation of EVT in patients with acute ischemic stroke. Its impact on functional outcome needs to be determined.

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Analysis of Mechanical Thrombectomy for Acute Ischemic Stroke on Nights and Weekends Versus Weekdays at Comprehensive Stroke Centers

Cited by 12 publications

References 28 publications

Workflow Intervals andOutcomesof Endovascular Treatment for Acute Large-Vessel Occlusion During On- Versus Off-Hours in China The ANGEL-ACT Registry

Workflow Intervals andOutcomesof Endovascular Treatment for Acute Large-Vessel Occlusion During On- Versus Off-Hours in China The ANGEL-ACT Registry

Workflow Intervals and Outcomes of Endovascular Treatment for Acute Large-Vessel Occlusion During On-Vs. Off-hours in China: The ANGEL-ACT Registry

Team Prenotification Reduces Procedure Times for Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion Who Are Transferred for Endovascular Therapy

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